Effects of adding thoracic extension exercises or thoracic kinesio taping to shoulder exercises on pain and function in adults with subacromial pain syndrome: a randomized controlled trial.

The influence of passive spinal structures on spinal geometric compensation during flexion-extension: A finite element analysis.

Retrospective cohort study. To evaluate the safety and efficacy of polymethyl methacrylate bone cement combined with calcium phosphate bone cement in percutaneous vertebroplasty for postmenopausal women, compared with polymethyl methacrylate bone cement alone. We analyzed the clinical data of 114 postmenopausal female patients who underwent single-level thoracolumbar PVP surgery at the Orthopedics Department of Baiyun Hospital, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2023 to June 2024.A total of 55 patients were included in the conventional group and 59 patients were assigned to the combined group, based on the type of filler used during the procedure.Comparative assessments included general demographic characteristics, low back pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, perioperative parameters (e.g., operative duration, intraoperative blood loss, time to ambulation), imaging findings, postoperative complications, and adverse events. All patients successfully underwent the procedure and were followed up for at least one year. No significant differences were observed in baseline data between the two groups.At postoperative follow-up, both groups showed significantly lower low-back pain Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores compared with preoperative values (P < 0.05). At 1day and 1 month after surgery, the combined group had significantly lower VAS and ODI scores than the conventional group (P < 0.05). However, by 1 year postoperatively, there were no significant differences in VAS or ODI scores between the two groups (P > 0.05).Compared with preoperative measurements, both groups exhibited significant improvement in lumbar lordosis angle, sagittal Cobb angle, thoracic kyphosis angle, thoracolumbar kyphosis angle, coronal Cobb angle, and vertebral body height at postoperative follow-up (P < 0.05).Furthermore, compared with the conventional group, the combined group demonstrated a lower incidence of cement leakage and adjacent vertebral refracture after PVP, as well as less residual postoperative back pain. In percutaneous vertebroplasty (PVP) for thoracolumbar vertebral compression fractures in postmenopausal women, the application of methyl methacrylate (PMMA) combined with calcium phosphate cement (CPC) is safe and effective. It significantly alleviates pain, improves surgical outcomes, and enhances patient satisfaction. The efficacy and safety of this combined approach are comparable to PMMA cement alone, with advantages in reducing back pain, improving quality of life, lowering the risk of cement leakage, and decreasing the incidence of adjacent vertebral fractures.

Many developmental and metabolic effects of growth hormone (GH) on vertebrate life history traits have been widely studied in biological and biomedical contexts. The scope of alterations in GH/GH receptor (GHR) interactions has generally focused on molecular, cellular, histological, and physiological framing, leaving a gap in understanding of how the cumulative organism- and lifespan-scale manifestations of morphological changes attributable to GH/GHR perturbations may both be influenced by and also influence smaller-scale study results. The pilot study conducted herein used micro-computed tomography (μCT) to survey and characterize the axial and appendicular skeletons of adult male and female bGH (transgenic overexpression of bovine GH) mice and to compare them with those of age- and sex-matched wild-type (WT) controls. Male and female bGH mice in our sample were larger (by linear measurements of skeletal elements) and leaner but not heavier than their WT counterparts. bGH mice exhibit thoracic kyphosis and radiographically detectable incipient sacralization of the last lumbar vertebra, as well as robust and altered muscle attachment sites in both girdle and long bones, re-orientation of the acetabulum, and dysmorphology of the femur at both hip and knee joints. bGH mice generally lack clear, radiologically determinable differentiation of long bone growth plates and bear larger and differently proportioned sesamoids at the elbow and knee. They are also preferentially subject to the accumulation of inferred heterotopic calcification (IHC) and other radiodense soft tissue (RST) around joints and entheses. Female bGH mice exhibit variable and aberrant morphology in the humerus, innominate, and femur not seen in other groups, and show the most size and shape variation within the four genotype × sex groupings. Our survey illustrates widespread musculoskeletal impacts of excessive GH into adulthood in the model. These data provide an initial whole-skeleton framework for further efforts characterizing molecular-, cellular-, and tissue-scale alterations ultimately influencing the bGH mouse model skeletal phenotype. This pilot work serves to contextualize future preclinical studies as well as broader investigations into how GH and its metabolic cascade may affect vertebrate morphological and histological development, shape and size disparity, and dimorphism.

This study explores the relationship between thoracic sagittal kyphotic alignment, quantified by the Cobb angle, and postoperative shoulder function, specifically assessing whether the presence and severity of thoracic kyphosis influence clinical outcomes and range of motion (ROM) in patients undergoing reverse shoulder arthroplasty (rTSA). A retrospective review was conducted on 110 patients who underwent rTSA from 2020 to 2022 at a single institution. Sagittal kyphosis was quantified on preoperative chest radiographs. Clinical outcomes were measured using the visual analog scale (VAS), constant score (CS), simple shoulder test, Single Assessment Numeric Evaluation (SANE) score, and pre- and postoperative ROM. Patients were separated into three groups based on Cobb angle severity (0-36°, 37-46°, ≥47°) and followed for a minimum follow-up of 2 years. A p-value <0.05 was considered statistically significant. Patients with a Cobb angle ≥47° exhibited a significant reduction in flexion (132.7° vs 149.4° for Cobb ≤36°; p = 0.031) and abduction (122.9° vs 142.1°; p = 0.035). This group also showed lower mean CSs (75.1 vs 83.3; p = 0.048). No significant differences were observed among groups in SANE or VAS pain scores. Greater thoracic kyphosis is associated with reduced functional outcomes and diminished flexion and abduction following rTSA. These findings suggest that sagittal spinal alignment may influence postoperative shoulder performance. Retrospective Cohort Comparison III.

Immediate changes in thoracic spine mobility after repetitive pitching in high school baseball players: A randomized controlled trial.

Study DesignRetrospective study.ObjectivesPelvic incidence (PI) is traditionally considered a fixed anatomical parameter; however, postoperative variability has been reported in adult deformity cohorts. Data regarding PI behavior in adolescent Scheuermann’s kyphosis (SK), particularly according to deformity subtype and distal fusion level, remain limited. This study aimed to evaluate PI variability in thoracic (TSK) and thoracolumbar (TLSK) SK and to analyze its relationship with spinopelvic parameters.Methods102 consecutive SK patients who underwent single-stage posterior pedicle screw fusion(2015–2021) were retrospectively reviewed; 52 met inclusion criteria (TSK n=30,TLSK n=22). Thirty age-matched healthy controls were included. Radiographic parameters (TK,TLK,GK,LL,CL,PI,PT,SS,SVA,PI–LL mismatch) were measured on standardized standing whole-spine radiographs. Reliability was assessed using ICC and smallest detectable change(SDC95). Intergroup comparisons, correlation, and exploratory multivariate regression analyses were performed.ResultsReliability for PI, PT, and SS was excellent(ICC 0.92–0.97). Preoperatively, TLSK demonstrated lower PI and SS than TSK(p<0.05). At final follow-up(mean 4.6±2.2 years), PI increased significantly in TLSK (ΔPI +6.18°), exceeding SDC95, whereas no significant change was observed in TSK. The intergroup ΔPI difference was 5.22°(p=0.050). Distal fusion(≥L3) was associated with greater ΔPI. ΔPI correlated positively with postoperative PT and SS and negatively with LL. In multivariate analysis, postoperative PT(positive) and LL(negative) remained independently associated with ΔPI (R2=0.345, p=0.001).ConclusionsTLSK patients exhibit lower baseline PI and modest postoperative PI increase compared with TSK. Postoperative PI variability appears related to pelvic posture and lumbar alignment rather than definitive anatomical remodeling. These findings highlight the importance of comprehensive spinopelvic assessment during surgical planning and follow-up of Scheuermann kyphosis.

Posterior vertebral column resection (PVCR) for severe post-traumatic thoracic angular kyphosis is effective but carries high morbidity. This study compares unilateral PVCR (UPVCR) with traditional bilateral PVCR (BPVCR), hypothesizing that UPVCR is non-inferior to BPVCR in deformity correction while offering improved perioperative outcomes in appropriately selected patients with an intact contralateral osseo-ligamentous tension band. A retrospective cohort study of patients who underwent PVCR for post-traumatic thoracic angular kyphosis (January 2019 - June 2023) at a tertiary academic center was conducted. Of 58 screened patients, propensity-score matching (1:1) on age, preoperative kyphotic angle, vertebral level, BMI, and preoperative neurological status yielded 40 patients (UPVCR: n = 19; BPVCR: n = 21) with a minimum 24-month follow-up. The primary outcome was correction of the local kyphotic angle. A pre-specified non-inferiority margin of 10° was defined for kyphotic angle correction. Secondary outcomes included operative time, estimated blood loss (EBL), complications, hospital stay, additional radiographic parameters, and patient-reported outcomes (VAS, ODI). All secondary outcome analyses are exploratory and unadjusted for multiplicity. UPVCR was applied exclusively for patients with an intact contralateral tension band and without severe rotational deformity (axial Cobb < 15°); a selection criterion that inherently limits direct comparability and is addressed in detail in the Limitations section. UPVCR met the pre-specified non-inferiority threshold for kyphotic angle correction (mean difference - 1.9°; 95% CI - 4.3° to + 2.1°; upper bound < 10° margin). UPVCR was associated with significantly shorter operative time (179.7 ± 12.5 vs. 269.3 ± 13.8min, p < 0.001), lower EBL (740.5 ± 96.4 vs. 1378.6 ± 348.8 mL, p < 0.001), and a shorter hospital stay (5.6 ± 1.2 vs. 9.2 ± 1.6 days, p < 0.001). Complication rates were 10.5% for UPVCR and 19.0% for BPVCR; this numerical difference did not reach statistical significance (Fisher's exact test, p = 0.67), and the study was not powered to detect differences in complication rates. Both techniques achieved comparable correction in sagittal vertical axis (SVA) and pelvic incidence-lumbar lordosis (PI-LL) mismatch, with no differences in correction loss or cage subsidence. Clinical outcomes (VAS, ODI) improved significantly and similarly in both groups. In appropriately selected patients, specifically those with focal angular post-traumatic kyphosis, an intact contralateral tension band, and no severe rotational component, UPVCR demonstrates radiographic and clinical outcomes that are non-inferior to BPVCR for kyphotic angle correction, while showing statistically significant reductions in operative time, blood loss, and hospital stay. Complication rates, while numerically lower, did not differ significantly between groups, and this study was underpowered to evaluate complications. Confirmation in larger, prospective, adequately powered studies is required before practice recommendations can be made.

The relationship between distal lumbar lordosis correction and early postoperative L1-pelvic angle changes in adult spinal deformity surgery.

Kümmell disease is a prevalent spinal condition characterized by vertebral fractures and subsequent spinal nerve injury, significantly impacting patients' quality of life and imposing a considerable economic burden on society. Current treatment modalities, including percutaneous vertebroplasty (PVP) and kyphoplasty (PKP), often fail to alleviate symptoms or restore vertebral height in advanced stages of the disease, highlighting the urgent need for improved surgical interventions. This study aims to evaluate the surgical outcomes of short-segment fixation combined with leverage reduction technique in patients with Kümmell disease accompanied by kyphosis deformity. A retrospective analysis was conducted on 22 patients who were treated with short-segment fixation and leverage reduction technique between 2020 and 2023. Clinical evaluation, including operation time, blood loss volume, and postoperative complications, were collected. The visual analog scale (VAS) score for pain and Frankel classification were used to evaluate the patients' functional outcome. The radiographic analysis included local kyphotic angle (LKA), regional kyphotic angle (RKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and sagittal compression (SC). The student t-test and the χ2-test (or the Fisher exact test) were used to compare the outcome measures between the preoperative group and postoperative group. The results demonstrate that the surgical technique led to limited intro-operative blood loss (average 85.7 ± 29.4 mL) and short surgery duration (average 100.1 ± 36.3 min), and significantly improved pain status postoperatively (p < 0.05). Average vertebral height restoration reached 83% ± 14% of predicted normal height, with mean kyphotic angle correction of 19.32° ± 6.27°. Notably, the proportion of patients classified as Frankel grade D and E improved significantly at the last follow-up (p < 0.05), indicating favorable neurological recovery. Although there was an instance of cement leakage, no severe complications such as internal fixation failure or neurological damage occurred. The results suggest that short-segment fixation combined with leverage reduction technique is a promising surgical strategy for patients with Kümmell disease and kyphosis deformity, effectively alleviating pain, restoring vertebral height, and promoting neurological recovery.

Forward head posture (FHP) is one of the most frequently reported postural deviations in contemporary populations. Therapeutic exercise has been associated with improvements in FHP, rounded shoulders, and thoracic kyphosis. However, it remains unclear whether exercise programs targeting the neck region differ in their effects from those that also include the thoracic spine compared with control conditions. A systematic review with meta-analysis was conducted following a comprehensive search of the Cochrane Library, PubMed, PEDro, and Web of Science databases from inception to 9 February 2026. Eligible studies were randomized controlled trials investigating therapeutic exercise interventions in patients with FHP. The intervention had to be based on therapeutic exercise. Studies were required to compare the intervention with a control group. Methodological quality was assessed using the PEDro scale, and the certainty of the evidence was evaluated according to the GRADE guidelines. Thirteen randomized controlled trials involving 819 participants were included in qualitative synthesis and meta-analysis. Both neck-focused exercise and combined neck - thoracic exercise programs showed statistically significant short-term improvements in craniovertebral angle and neck disability compared with control conditions. Combined neck - thoracic exercise programs demonstrated significant reductions in pain intensity post-intervention. The certainty of the evidence ranged from low to very low. Therapeutic exercise programs targeting the neck region, alone or combined with thoracic exercises, may improve craniovertebral angle and neck-related outcomes in individuals with FHP. However, the certainty of the evidence ranged from low to very low and the findings should be interpreted with caution. PROSPERO registration ID CRD420261304664.

Evidence linking backpack load to pediatric back pain is inconsistent, and imaging data under load are scarce. We quantified acute backpack-related changes in sagittal alignment using standing whole-spine radiographs in school children. Sixty-five healthy schoolchildren underwent standing lateral whole-spine radiography under three within-participant conditions: unloaded, low-load (target 10-15% body weight), and high-load (approximately 50% greater than low load). Habitual exposure (usual backpack weight and commute time) was related to unloaded alignment using multivariable linear regression, focusing on sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), and pelvic tilt (PT). Load-alignment associations were examined using linear mixed-effects models with measured applied load (% body weight) as a predictor. Abnormal SVA (≥ 40mm) under loading was examined using a generalized linear mixed-effects model. Receiver operating characteristic (ROC) analysis and the area under the curve (AUC) evaluated applied load for discriminating abnormal SVA. Habitual backpack weight and commute time were not independently associated with unloaded SVA, PI-LL, or PT. Increasing applied load was associated with higher SVA and thoracic kyphosis and with lower PT, while lumbar lordosis changed minimally. Applied load increased the odds of abnormal SVA (odds ratio 1.526 per 1% increase in applied load; p < 0.001), whereas greater grip strength was protective (odds ratio 0.752; p = 0.037). ROC analysis showed an AUC of 0.725 with an optimal cut-off of 16.0% body weight. Backpack loading acutely shifts sagittal alignment forward in schoolchildren on whole-spine radiographs. Clinically meaningful pediatric thresholds under load warrant further study.

The aim of the research is to develop a method of registering spinopelvic balance parameters employing shadow moiré topography (SMT) and to use this diagnostic method while clinical observation of adolescents with functional and spine disorders. The subject of the study was a group of adolescents aged 12-17 (n = 50) with the symptoms of mild or moderate scoliosis (according to Cobb). SMT was employed as a clinical diagnostic method. The obtained values were compared with the values provided by the analysis of the standard thoracic and lumbar spine radiographs. The Mann-Whitney U-test was used to evaluate the differences between the values provided by radiography and SMT (due to a small number of subjects). The differences were considered significant at the criterion level α = 0,05, α = 0,01. The data were processed using built-in functions and small self-documenting codes for the Microsoft Office Excel 2013 program. Follow-up data analysis showed no significant differences with the probability of 95% (α = 0,05) in thoracolumbar kyphosis, pelvic incidence, and sagittal vertical axis values, whereas the differences are significant with the probability of 99% (α = 0,01) in the Cobb angle, Lumbar lordosis (LL1), and sacral slope values and with the probability of 95% (α = 0,05) in thoracic kyphosis values. The research found that SMT employed as a diagnostic method in vertebrogenic pathology is reliable and valid and can be employed as a screening, diagnostic, and monitoring tool in the vertebral column state while medical rehabilitation of adolescents with scoliosis.

Generalized joint hypermobility (GJH) is prototypical clinical feature of hypermobility spectrum disorders, and emerging studies have found a correlation between GJH and structural spinal changes. This study aims to investigate the preoperative radiographic characteristics and clinical outcomes of patients with GJH and adolescent idiopathic scoliosis (AIS). Patients with AIS were prospectively recruited between July 2023 and August 2024 and divided into GJH (Beighton score ≥ 6) and non-GJH (Beighton score < 6) groups. The GJH group was matched 1:1 with controls based on age (±1 year), sex, main curve magnitude (±5°), curve type of the Lenke classification, triradiate cartilage status, and Risser stage (±1 grade). Baseline characteristics and surgical data were recorded. Preoperative and immediately postoperative radiographic parameters were measured. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was collected preoperatively and at least 1 year postoperatively. Univariate analysis and multivariable linear regression analysis were used to identify factors associated with main curve flexibility, TK, and T1 tilt angle. A total of 136 consecutive patients were included, with 29 patients (21.3%) classified into the GJH group. After mating, the GJH showed greater flexibility of the main curve (60.0% ± 27.7% vs. 45.8% ± 22.1%, p = 0.020) and increased thoracic kyphosis (22.9° ± 11.5° vs. 16.7° ± 11.7°, p = 0.031) compared to the control group. Multivariable linear regression analyses revealed that the GJH was correlated with increased spinal flexibility (β = 14.09, p = 0.015) and larger thoracic kyphosis (β = 6.11, p = 0.043). The GJH group demonstrated a relatively higher risk of surgical complications compared to the non-GJH group (17.2% [5/29] vs. 4.7% [5/107], p = 0.036). However, no significant differences were observed in patient-reported outcome measures (PROMs) between the two groups. In patients with AIS, GJH is associated with increased spinal flexibility and greater thoracic kyphosis and, importantly, a higher risk of surgical complications.

The purpose of this study was to evaluate the efficacy of multirod constructs in the treatment of young patients (<20 years) with scoliosis accompanied by lumbosacral deformity and to compare the corrective outcomes and postoperative quality of life between 3-rod and 4-rod techniques. Thirty-nine adolescent patients with lumbosacral anomalies underwent surgical treatment at our institution. Following application of the inclusion/exclusion criteria, 17 young patients with severe scoliosis and concomitant lumbosacral deformities were enrolled in this study. Preoperative, 1-week postoperative, and final follow-up standing whole-spine anterior-posterior/lateral radiographs were retrospectively analyzed. The following parameters were assessed: major curve Cobb angle, lumbosacral curve Cobb angle, trunk shift, thoracic kyphosis angle, lumbar lordosis angle, and sagittal vertical axis (SVA), In addition, Scoliosis Research Society-22 (SRS-22) questionnaire scores were collected and analyzed preoperatively and at the final follow-up. The lumbosacral Cobb angle improved from 33.6° ± 4.5° to 7.7° ± 2.8° postoperatively (P < 0.05), maintained at 8.6° ± 2.6° during follow-up. The major curve decreased from 62.1° ± 8.3° to 19.6° ± 6.5° (P < 0.05), with slight correction loss to 23.3° ± 6.1° at follow-up. Trunk shift reduced from 3.0 ± 1.5 cm to 1.1 ± 0.7 cm (P < 0.05), stabilizing at 1.4 ± 0.6 cm. Sagittal measurements showed TK improved from 29.8° ± 6.0° to 33.3° ± 5.0° postoperatively (P > 0.05), whereas lumbar lordosis increased from 34.2° ± 19.4° to 43.0° ± 7.3° (P > 0.05). SVA changes were notable (P < 0.05). SRS-22 self-image scores improved from 2.21 ± 0.64 to 3.79 ± 0.50 (P < 0.001), with pain scores also enhanced from 4.02 ± 0.58 to 4.71 ± 0.17 (P < 0.001). No statistically significant differences were observed in correction rates or final follow-up SRS-22 scores between 3-rod and 4-rod constructs (P > 0.05). The multiple-rod technique effectively addresses severe scoliosis with lumbosacral deformities in young patients, providing sustained radiographic correction, reduced implant failure risk, and improved clinical outcomes. In long-segment lumbosacral fixation constructs, bilateral supplementary rod configuration may reduce rod fracture risk compared with unilateral reinforcement.

The aim of this study was to investigate the incidence and risk factors of lumbar spondylolysis in adolescent rugby players. A prospective cohort design over a 9-month season (June 1, 2021-February 28, 2022) was used. A set of adolescent rugby players of male sex participated in this study and physical function examination were measured before injury surveillance. A total of 185 adolescent rugby players participated in this study. Bilateral passive range of motion of the hip, rectus femoris muscle flexibility, hamstring flexibility, and thoracic kyphosis angle were assessed. All participants were followed for a 9-month season (from June 2021 to February 2022) to determine the injury incidence during matches and training. A total of 25 players (14.4%) had a lower back injury. The 18 players (72.0%) who reported injuries of the lower back were diagnosed with spondylolysis. A smaller passive hip external rotation range of motion on the right side and larger thoracic kyphosis angle were associated with lumbar spondylolysis. Restricted hip external rotation flexibility and round posture may be risk factors for lumbar spondylolysis in adolescent rugby players. Prospective cohort, level 2.

The study of spinopelvic alignment in asymptomatic individuals is essential for understanding physiological sagittal balance and establishing reference values for spinal deformity assessment. However, the availability of large datasets of healthy subjects is limited by ethical, logistical, and radiation-related constraints. Artificial intelligence (AI)-based synthetic data generation may represent a promising strategy to overcome these limitations. Full-spine standing radiographs from 123 asymptomatic subjects were retrospectively analyzed. Demographic characteristics and multiple spinopelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and cervical alignment measures, were recorded. An AI-driven probabilistic Gaussian resampling approach with anatomical constraints was used to generate a synthetic dataset of 10,000 biologically plausible cases. Correlations identified within the synthetic dataset were subsequently validated against the original cohort using Pearson correlation analysis and bootstrap resampling (1,000 iterations). The synthetic dataset preserved the statistical distribution of the original population while substantially increasing analytical power. Significant correlations were identified between PI and PT (PT = 0.34 × PI - 7.2), PI and SS (SS = 0.66 × PI + 7.2), and PI and LL (|LL| = 0.55 × PI + 32.0). These relationships were consistent with previously published anatomical models and remained robust when tested in the original cohort and through bootstrap validation. No significant correlation was observed between PI and TK. A significant association was also identified between T1 slope and cervical lordosis. AI-driven dataset amplification represents a feasible and reproducible approach for investigating spinopelvic relationships in limited clinical cohorts. The combination of synthetic data generation, validation on real-world observations, and bootstrap resampling enables the identification of biologically plausible correlations while minimizing the need for additional imaging studies. This methodology may serve as a valuable exploratory tool in spine research and other fields characterized by limited datasets.

AI-derived versus surgeon-performed instrumentation in adolescent idiopathic scoliosis: a biomechanical simulation analysis.

Osteonecrosis of the femoral head (ONFH) involves femoral head collapse, leading to hip joint pain, low back pain (LBP), and reduced quality of life. While compensatory spinopelvic alignment (SPA) changes are well-documented in hip osteoarthritis, their relationship with ONFH progression remains poorly understood. This study aimed to investigate SPA changes across different ONFH stages and evaluate the effects of total hip arthroplasty (THA) on SPA and patient-reported outcome measures (PROMs), including LBP, in patients undergoing THA at early and late stages of ONFH. This retrospective study included 82 patients with ONFH who underwent THA. Patients were classified into three groups based on ONFH stage using the Japanese Investigation Committee classification: stage 2 and 3A, stage 3B, and stage 4. Preoperative and postoperative SPA parameters (pelvic incidence, lumbar lordosis [LL], sacral slope [SS], pelvic tilt [PT], thoracic kyphosis, and sagittal vertical axis [SVA]) and PROMs (Japan Hip Disease Evaluation Questionnaire [JHEQ] and LBP Visual Analog Scale [VAS] scores) were compared across stages. SPA and PROMs were investigated preoperatively and 2years postoperatively. Preoperative SPA analysis revealed increased SS and SVA as ONFH progressed. Postoperatively, THA significantly reduced LL, SS, and SVA while increasing PT, with similar trends across all stages. Notably, stage 4 patients exhibited significantly greater increases in posterior PT. PROMs, including JHEQ and LBP VAS scores, improved significantly across all stages postoperatively, with no significant differences in the degree of improvement. THA improves compensatory SPA changes and PROMs in ONFH cases, regardless of the disease stage. However, patients with advanced-stage ONFH may experience further progression of the posterior PT postoperatively, highlighting the importance of preoperative SPA evaluation in late-stage cases.

Objective:To evaluate the applicability of tracheostomy tube for patients with cervical or upper thoracic kyphosis, and establish a preoperative imaging evaluation system for tracheotomy in patients population. Methods:The three-dimensional（3D） geometry of the neck were reconstructed using computed tomography scans for patients with cervical or upper thoracic kyphosis. The local kyphosis angle of vertebral body, the total kyphosis angle of cervical spine, the distance between trachea and skin and the height of innominate artery were measured. 3D models of tracheostomy tubes were generated using geometric modeling software. Tracheostomy was simulated in the virtual 3D models. The distance between the tube tip and the inner tracheal wall was measured to analyze whether the tracheostomy tube was suitable for patients with cervical or upper thoracic kyphotic deformity. Results:64% of patients with cervical or upper thoracic kyphosis were not fitted with the tracheostomy tubes. The Pearson coefficient is 0.927 and R² is 0.860 between the angle of cervical kyphosis and the distance between the cannula and tracheal wall. According to the ROC curve analysis, when the angle of cervical kyphosis exceeded 33.32 degree, the tracheostomy tube became unsuitable, with both sensitivity and specificity equal to 1. Conclusion:The tracheostomy tube is not suitable for the majority of patients with cervical or upper thoracic kyphosis. This study established a preliminary preoperative imaging evaluation system for difficult tracheotomy in patients with cervical or upper thoracic kyphosis, and proposed a 33.32 ° cervical total kyphosis angle as a reference standard for tracheostomy tube adaptation during tracheotomy for patients with cervical or upper thoracic kyphosis. In addition, this study provides initial validation that three-dimensional reconstruction and preoperative planning of tracheotomy position can avoid postoperative complications caused by poor position of the tube in these patients.